Healthcare Provider Details

I. General information

NPI: 1841258274
Provider Name (Legal Business Name): KATHLEEN ELLEN TALBOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ELLEN THOMPSON LPN

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 17TH AVE
COLUMBUS OH
43219-1002
US

IV. Provider business mailing address

2780 AIRPORT DR STE 100
COLUMBUS OH
43219-2289
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-2700
  • Fax: 614-645-5517
Mailing address:
  • Phone: 614-859-1906
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.053141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: